During the past year we have continued our work applying rapid MRI to guide simple and complex mechanical and biological interventions. We continue to employ MRI catheterization as standard clinical practice at the NIH clinical center, based on our earlier careful pilot research comparison of conventional X-ray and wholly MRI guided transfemoral pulmonary artery catheterization in adults. We continue to enhance the capabilities of MRI catheterization to characterize heart function in patients. We have begun investigational MRI catheterization in children with congenital heart disease, to avoid radiation that can cause long term complications. So far we have performed the procedure in 10 patients at our collaborative facility at Childrens National Medical Center in Washington DC. We are developing new approaches to connect different heart chambers without surgery in patients with congenital heart disease. We also continue work towards direct repair of congenital heart defects on small children who otherwise might require open surgical access. We continue a strategic project to connect the great veins to the pulmonary arteries (also known as cavopulmonary shunts, Glenn shunts, Fontan shunts) in animals, and expect to be able to translate this into the care of children in upcoming years. We have developed a surprisingly useful and completely new technique to access the aorta without surgery in patients with small (especially women) and diseased leg arteries. We have taught over twenty medical centers on three continents how to use this technique in their patients. We have begun a multi-center FDA-regulated trial of this technique, which so far has been used successfully in over 135 patients worldwide. We also continue work on a custom device to make the technique safer, that we hope to introduce into clinical practice in the future. We have developed a new way to enter the pericardial space to treat structural heart disease and rhythm disorders. We poke a small hole form the inside out of the right atrial appendage and then fill the pericardial space with carbon dioxide gas. This pushes the heart away from the outer pericardial surface and allows devices to be introduced safely to the outer surface of the heart. After developing the technique in animals at our NIH site, we successfully applied this approach to patients at our Henry Ford collaborative site. We have provided multiple hands-on training courses where we teach physician teams from USA and abroad how to equip and operate an MRI catheterization facility. Overall we have successfully developed novel applications of real-time MRI for cardiovascular treatments, and we continue to work to clinical applications of these exciting new developments.